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J Heart Lung Transplant. 2014 Feb;33(2):157-62. doi: 10.1016/j.healun.2013.10.008. Epub 2013 Oct 11.

Usefulness of pulmonary capillary wedge pressure as a correlate of left ventricular filling pressures in pulmonary arterial hypertension.

Author information

1
Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil.
2
Hemodynamic Unit, Division of Cardiology, Federal University of São Paulo, São Paulo, Brazil.
3
Pulmonary Vascular Group, Division of Respiratory Medicine, Federal University of São Paulo, São Paulo, Brazil. Electronic address: jaqueota@gmail.com.

Erratum in

  • J Heart Lung Transplant. 2014 Apr;33(4):459. de Oliveira, Rudolf K F [corrrected to Oliveira, Rudolf K F].

Abstract

BACKGROUND:

Pulmonary arterial hypertension (PAH) is characterized by a pulmonary capillary wedge pressure (PCWP) of ≤15 mm Hg, given a normal left ventricular filling pressure (LVFP). However, recent studies have shown that, in PAH patients, diagnosis based on PCWP can erroneously classify a significant number of patients compared with diagnosis based on left ventricular end-diastolic pressure (LVEDP). Therefore, we sought to compare the diagnostic accuracy of end-expiratory PCWP and LVEDP measurements in patients suspected of having pulmonary hypertension (PH).

METHODS:

We reviewed the hemodynamic data from 122 patients suspected of having PH who underwent simultaneous right- and left-side heart catheterizations at a PH referral center from 2006 to 2011.

RESULTS:

PH was diagnosed in 105 patients, 79% of whom (n = 83) showed a pre-capillary pattern according to the LVEDP measurement. Ninety percent of patients with PCWP ≤15 mm Hg were correctly classified as having pre-capillary PH. However, 39% of patients with a PCWP >15 mm Hg had LVEDP ≤15 mm Hg and would have been erroneously diagnosed with pulmonary venous hypertension based on their PCWP measurements alone. The sensitivity and specificity was 0.89 and 0.64, respectively. A Bland-Altman analysis of the PCWP and LVEDP measurements revealed a mean bias of 0.3 mm Hg with 95% limits of agreement of -7.2 to 7.8 mm Hg.

CONCLUSIONS:

A PCWP ≤15 mm Hg was found to be a reliable indicator of normal LVFP in pre-capillary PH patients. When measured properly and analyzed in the clinical context, PCWP is a valuable tool for accurate diagnosis of PAH.

KEYWORDS:

left ventricular end-diastolic pressure; left ventricular filling pressure; pulmonary arterial hypertension; pulmonary capillary wedge pressure; right heart catheterization

PMID:
24268673
DOI:
10.1016/j.healun.2013.10.008
[Indexed for MEDLINE]

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